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Latest Findings Published on The Lancet Jointly by PUMCH and the Cleveland Clinic: Mild Hypothermia Does Not Affect Postoperative Major Cardiovascular Events
CopyFrom: PUMCH UpdateTime: 2022-05-07 Hits: 6 Font Size: SmallBig

In the past decades, it was experts’ consensus that intraoperative hypothermia might promote myocardial injury, surgical site infections and blood loss, and recommended that intraoperative core temperature of patients should be kept at least 36°C. On April 4, 2022, “The Lancet” published online the findings of an international multicenter research on the prevention and control of intraoperative hypothermia jointly completed by Prof. Daniel I. Sessler of the Cleveland Clinic, Prof. Huang Yuguang and Associate Prof. Pei Lijian of PUMCH, and Associate Prof. Li Kai of China-Japan Union Hospital of Jilin University: There was no significant difference in outcome indicators between patients with intraoperative hypothermia (35.5°C) and normothermia (37°C). Mild hypothermia in surgical patients does not affect postoperative cardiovascular events and keeping core temperature at least 35.5°C in surgical patients appears sufficient.

To further explore the relationship between moderate and mild intraoperative hypothermia and postoperative cardiovascular events and complications in patients, Prof. Huang Yuguang and Associate Prof. Pei Lijian took the lead in organizing 10 medical institutions in China to conduct a research. From March 27, 2017 to March 16, 2021, the trial enrolled a total of 5,056 patients. The subjects were aged ≥45 years, underwent non-cardiac surgery under general anesthesia with the operation time expected to be within 2 to 6 hours, and had at least one risk factor for cardiovascular events. The study excluded dialysis patients and obese patients with BMI >30kg/m². Subjects were randomly assigned (1:1) to receive either aggressive warming or the routine thermal management.

During the operation, the patients assigned to the aggressive warming group maintained a mean final intraoperative core temperature of 37.1°C (SD 0.3) with the warming area exceeding 50% of the skin surface area available whereas the routine thermal management group averaged 35.6°C (SD 0.3).

The study conducted a 30-day post-operative follow-up. At least one of the primary outcome components (myocardial injury after non-cardiac surgery, cardiac arrest, or mortality) occurred in 246 (9.9%) of the patients in the aggressively warmed group and in 239 (9.6%) of the patients in the routine thermal management group. There was no significant difference in the relative risk of the composite endpoint of postoperative cardiovascular events between the two groups, and there was no significant difference in the secondary outcome indicators such as surgical site infection, perioperative blood transfusion, and second hospitalization.

This study shows that keeping core temperature at least 35.5°C in surgical patients is safe.

PUMCH and the Cleveland Clinic jointly published the research paper “Aggressive intraoperative warming versus routine thermal management during non-cardiac surgery (PROTECT): a multicenter, parallel group, superiority trial”.

Correspondent: Pei Lijian

Reporter: Gan Dingzhu

Picture: The Department of Anesthesiology

Translator: Liu Haiyan

Editor: Pei Lijian and Wang Yao